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Discusses constipation in those 11 and younger. Covers normal patterns of bowel movements. Covers hard stools and if and when children should be given laxatives. Offers home treatment tips. Includes interactive tool to help you decide when to call a doctor.

Constipation, Age 11 and Younger

Topic Overview

Constipation occurs
when stools become hard and are difficult to pass. Some parents are overly
concerned about how often their child has bowel movements, because they have
been taught that a healthy child has a bowel movement every day. This is not
true. The frequency of bowel movements is not as important as whether the child
can pass stools easily. Your child is not constipated if his or her stools are
soft and pass easily, even if it has been a few days since the last bowel
movement.

Newborns younger than 2 weeks should have at least 1 or
2 bowel movements a day. Babies older than 2 weeks can go 2 days and sometimes
longer between bowel movements. It's usually okay if it takes longer than 2
days, especially if your baby is feeding well and seems comfortable. Breast-fed
babies are more likely to have frequent stools and may have a stool as often as
every feeding. Constipation is likely to occur when a baby changes from breast
milk to formula, especially if this change happens during the first 2 to 3
weeks of life.

As babies grow older, the number of bowel movements
they have each day gets less and the size of their stools gets bigger. A child
age 3 or 4 years may normally have as many as 3 bowel movements a day or as few as 3
a week.

It is important for parents to recognize there are many
"normal" patterns for bowel movements in children. Some children may appear to
have trouble passing a stool. The child's face may turn red, and he or she
may strain to pass stool. If the stool is soft and the child does not seem to
have other problems, this is not a concern.

Most children will
occasionally become constipated. The problem is usually short-lived and does
not cause long-term problems. Home treatment is usually all that is needed to
relieve occasional constipation. Causes of constipation include:

Changes in diet, such as when a child starts
eating more adult foods. Constipation may also occur if your child drinks too
much cow's milk. This happens most often in children younger than age
2.

Not drinking enough fluids. Sometimes the normal amount of fluid
a child drinks is not enough, such as when the weather gets hot or the child
increases his or her physical activities.

Not taking the time to
have a bowel movement. A child may be so interested in play that he or she
ignores the need to have a bowel movement.

Reluctance to use the
bathroom. A child might become constipated when he or she is in a new
environment, such as when traveling.

Changes in daily routine, such
as when traveling or after starting school.

Constipation may occur with cramping and pain if the child is
straining to pass hard, dry stools. He or she may have some bloating and
nausea. There may also be small amounts of bright red blood on the stool caused
by slight tearing (anal fissure) as the stool is pushed
through the
anus. All of these symptoms should stop when the
constipation is relieved.

Chronic constipation

For reasons that can't always
be identified, some children often develop constipation that does not get
better or go away with treatment (chronic constipation). The most significant
factor may be the painful passing of a hard, dry stool. After a while, the
child may be unable to resist the urge to have a bowel movement and will pass a
large mass of stool. The child may have to "push hard" during the bowel
movement, which may be painful. Passing the stool relieves the pressure and
pain until another mass of stool collects, and the cycle is repeated. Fear of
pain may cause the child to try to hold the bowel movement.

Other
causes of chronic constipation may include:

A crack (fissure) around the anus, which can
make bowel movements painful and cause the child to resist passing stools.
Fissures are a common problem that gets worse every time the child passes a
large stool.

A brief illness with poor food intake, fever, and
little or no physical activity, which may upset normal bowel
habits.

Emotional problems or toilet training problems, which can
lead to voluntarily withholding stools. A child may have fought the toilet
training process or been pushed too fast.
Struggling with parents for control may cause a child to hold stools back as
long as possible.

Change in environment. At school, children may
withhold stools because they are afraid or embarrassed to use school bathrooms,
their schedules are too busy for them to take time for a bowel movement, or
school activities interrupt their normal bowel movement time.

The child may be unable or unwilling to pass the stool
regardless of its size. Liquid or loose stool may leak out, soiling the child's
underwear. When this occurs in a child who is past the age of normal toilet
training, it is called
encopresis.

Chronic constipation usually
requires several months of treatment and cooperation between the parents, the
child, and the doctor to overcome the problem. Don't be discouraged if the
problem comes back during these months. The rectum is made of muscle tissue;
when a child has had chronic constipation, the muscle becomes stretched. It may
take several months to get the muscle back into shape.

In rare cases, constipation in children may be caused by
other health problems, such as:

Seek Care Now

Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

Call your doctor now to discuss the symptoms and
arrange for care.

If you cannot reach your doctor or you don't have
one, seek care in the next hour.

You do not need to call an
ambulance unless:

You cannot travel safely either by driving
yourself or by having someone else drive you.

You are in an area
where heavy traffic or other problems may slow you down.

What you are looking for is a change in your child's usual bowel habits.

Diarrhea means that the
child is having more stools and looser ones than usual.

Constipation means that the child is having fewer stools than
usual.

Every baby and child has different bowel habits. What is
"normal" for one child may not be normal for another. In general:

Many newborns have at least 1 or 2 bowel movements a day. By the end of their first week, they may have as many as 5 to 10 bowel movements a day. They may pass a stool after each feeding.

By 6 weeks of age, your baby may not have a bowel movement every day. This usually isn't a problem as long as the baby seems comfortable and is growing as expected, and as long as the stools aren't hard.

By about 4 years of age, it's normal for a child to have as many as 3 bowel movements a day or as few as 3
a week.

Anywhere in these ranges can be considered normal if the habit
is normal or usual for your child.

Try Home Treatment

You have answered all the questions. Based on your answers, you may be
able to take care of this problem at home.

Try home treatment to relieve the
symptoms.

Call your doctor if symptoms get worse or you have any
concerns (for example, if symptoms are not getting better as you would expect).
You may need care sooner.

Many prescription and nonprescription medicines can cause
constipation. A few examples are:

Antacids.

Antidepressants.

Some
blood pressure medicines.

Cold medicines
(antihistamines).

Calcium and iron
supplements.

Narcotic pain medicines.

Home Treatment

Constipation can usually be treated
effectively at home.

Make sure your child is drinking adequate amounts
of fluids.

If you are switching from breast milk to formula, give
your baby no more than
1 fl oz (30 mL) to
2 fl oz (60 mL) of water and no
more than 2 times each day for the first 2 to 3 weeks. Be sure to give your
baby the suggested amount of formula for feedings plus the extra water between
feedings. Do not give extra water for longer than 3 weeks unless your doctor
tells you to. Do not give plain water to a baby younger than 2 months.

If your child is older than 6 months, add fruit juices, such as apple, pear, or
prune juice, to relieve the constipation.

Limit foods that have little or no fiber, such as ice cream, cheese, meat, and processed foods, if your child gets constipated easily.

Gently
massage your child's belly. This may help relieve discomfort. You can also have
your child lie on his or her back, legs flexed onto his or her belly, and
rotate his or her legs in a clockwise direction.

If your child is
having rectal pain because he or she is unable to have a bowel movement, try
the following:

A warm bath in the tub. This may help relax
the muscles that normally keep stool inside the
rectum (anal sphincter) and help pass the stool.

If your child is age 6 months or older and the warm bath does not
work, use 1 glycerin suppository to lubricate the stool, making it
easier to pass. Use glycerin suppositories only once or twice. If constipation
is not relieved or develops again, discuss the problem with your doctor.

Do not give laxatives or enemas to children without
first talking to your doctor. Children should not need an enema or laxatives to
have a bowel movement.

Limit foods that have little or no fiber, such as ice cream, cheese, meat, and processed foods, if your child gets constipated easily.

Set a good example for your child by drinking
plenty of fluids and eating a high-fiber diet.

Toilet training

Constipation sometimes becomes a
problem when children start toilet training:

Encourage your child to go when he or she feels
the urge. The bowels send signals when a stool needs to pass. If your child
ignores the signal, the urge will go away, and the stool will eventually become
dry and difficult to pass.

Set aside relaxing times for having
bowel movements. Urges usually occur sometime after meals. Establishing a daily
routine for bowel movements, such as after breakfast, may help.

Make sure your child has good foot support while he or she is on
the toilet. This will help flex your child's hips and place the pelvis in a
more normal "squatting" position for having a bowel movement.

Make
sure your child gets plenty of exercise throughout the day. Set a good example
for your child by following healthy routines of eating, exercising, and going
to the toilet.

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How this information was developed to help you make better health decisions.